Donna, aged 58, had complained intermittently of bloating and abdominal pain for two years.
Her GP prescribed an antispasmodic, mebeverine, and referred her to a dietitian then a gastroenterologist. The latter diagnosed her with irritable bowel syndrome. Her GP did not see Donna again until nearly a year later, when she presented with abdominal swelling.
Clinical examination revealed ascites. Ultrasound confirmed this and showed a pelvic mass. Serum CA125 was markedly elevated at 1000. Donna was referred to a local gynaecologist and then to a gynaecological oncologist.
At laparotomy, extensive tumour deposits were seen over the peritoneum, mesentery and multiple bowel loops. A total abdominal hysterectomy, bilateral salpingo-oophorectomy and omentectomy were performed. Residual tumour nodules were all <0.5cm in diameter, implying optimal tumour debulking.
Histology showed typical